A retrospective review of stillbirths at the national hospital in Timor‐Leste

Abstract

This study highlights the need for standardised recording and coding of perinatal deaths at HNGV. The high proportion of antenatal death transfers from community health centres demonstrates the need for community and hospital staff training to improve the quality of antenatal and intrapartum obstetric care. A prospective study of stillbirths is recommended to obtain reliable data on the determinants of stillbirths in Timor-Leste. These data would inform evidence-based interventions for the improvement of maternity and obstetric care in community and hospital settings.

A prospective review of perinatal mortality at Hospital Nacional Guido Valadares (HNGV)

“…The simplified CODAC classification system was developed for use in resource‐poor settings where most deaths occur outside hospitals and where there are limitations in investigative capacity. The CODAC system was relatively easy to apply but approximately 45% of stillbirths in our study were ‘unknown’, only a slight improvement from 62% in Wilkins’ previous retrospective review . This is in contrast to studies undertaken in other LMIC settings using the CODAC classification system where the proportion of ‘unknown’ causes ranged from 8% to 25% .…”

“…Verification and induction for patients with suspected fetal demise are often unavailable at peripheral sites and therefore suspected cases of stillbirth are referred to the national hospital for further assessment and management. Wilkins et al ., found a stillbirth rate of 29/1000 births in the only other published study of stillbirths in Timor‐Leste, a retrospective audit of stillbirths over a 12 months period. Wilkins’ study was conducted at the same institution but did not include early neonatal deaths, which are often associated with adverse intrapartum events.…”

Cause of death and associated conditions of stillbirths

“…Hypertensive disorders (34.63%), intrapartum fetal loss (27.13%) and abruption (11.54%) were the three main causes of stillbirth. Similar 11 In a population based study by Bukowski R et al, out of 663 women with stillbirth, a possible or probable cause of death in 390 was identified. The most common causes were obstetric conditions (29.3%), placental abnormalities (23.6%), fetal genetic/structural abnormalities (13.7%), infection (12.9%), umbilical cord abnormalities (10.4%), hypertensive disorders (9.2%), and other maternal medical conditions (7.8%).…”

Missing stillbirth data: a hospital based study

“…15 In a study in west Timor's largest referral hospital fiftytwo of the 153 stillbirths (34%) had no maternal or obstetric details, in 62.7% of stillbirths cause of death was recorded as unknown, and condition at the time of birth (i.e fresh or macerated) was not ducumented. 5 The definition recommended by WHO for international comparison for stillbirth is "a baby born with no signs of life at or after 28 weeks' gestation or birth weight >1000gm". 16 Failure to adhere to WHO definitions hampers stillbirth epidemiology.…”

“…However, the administrative datasets has been better than the selfreporting data. 5 Birth registries across the world has observed missing data on birth weight, gestational age, or stillbirths. [6][7][8] In India inadequacy has been observed in monitoring of the time and cause of death of unborn infants.…”